Description
Obesity affects 36% of US women and men and increases lifetime risk for diabetes and
cardiovascular disease. Similarly, depression affects 20% of US women and 13% of men
and is the leading cause of disability worldwide. Further, the 2 disorders have a
bidirectional positive relationship.
Proven behavioral interventions to treat obesity and depression exist; however, the underlying biological mechanisms remain unknown. This lack of understanding significantly hampers efforts to optimize the effectiveness of behavioral interventions and limits their dissemination and implementation into widespread practice to curtail the adverse consequences of obesity and depression and promote population health.
Rapid advances in human neuroscience and behavioral science and integration of the two could provide unique opportunity to fill this gap. Objective: Leveraging a recently funded 2-year randomized controlled trial (RAINBOW, target n=404; PI Dr. Jun Ma) of a first-ever integrated treatment for comorbid obesity and depression in primary care that uniquely combines 2 nationally recognized behavioral interventions, we propose a 2-phased project to identify, validate, and refine a set of assays to measure self-regulation targets; and to engage these targets to optimize behavioral treatment of obesity and depression.
Specific Aims: In the UH2 phase, we will:
(1) Conduct secondary data analysis and hold workshops and a symposium to finalize selection of self-regulation targets and assays for testing
(2) Leverage the RAINBOW intervention to engage identified targets
(3) Verify target engagement across multiple domains (neural, physiological, behavioral, psychological), settings (laboratory, virtual, and naturalistic), and time points (0, 4 weeks, 6, 12 and 24 months).
Transitional milestones are to:
(1) Establish assay(s) that reliably and accurately measure the identified targets;
(2) Demonstrate malleability of the self-regulation target(s) in response to the RAINBOW integrated treatment
(3) Identify self-regulation profile(s) that predict treatment response in health behaviors (medical regimen adherence, physical activity, diet) and outcomes (weight, depression).
In the UH3 phase, we will conduct a pilot randomized controlled trial in which an additional 100 obese and depressed adults will be randomized to intervention or wait-list control and assessed at baseline, 4 weeks and 6 months.
Intervention subjects will receive the first 4 weeks of the RAINBOW intervention, followed by target-guided tailoring of the intervention components in order to optimize target engagement and enhance behavioral change based on their individual self-regulation profile during the first 4 weeks. We will use the insights from intervention subjects to then further refine the tailoring strategies for the waitlist subjects.
Implications: This research will provide a toolkit of well-validated assays of self-regulation targets important for health behavior change, as well as target-guided personalization of intervention strategies, in the treatment of comorbid obesity and depression.
Impact: Given the widespread relevance of these disorders and the targeted health behaviors, this research will be a prototype for treating multiple chronic conditions with profound potential impacts on population health.
PIs are Jun Ma, MD, PhD, University of Illinois at Chicago, and Leanne Williams, PhD, Stanford University.
Additional Co-Investigators are Jeremy Bailenson, PhD, Olivier Gevaert, PhD, Philip W. Lavori, PhD, all with Stanford University, and Mark B. Snowden, PhD, University of Washington.
Proven behavioral interventions to treat obesity and depression exist; however, the underlying biological mechanisms remain unknown. This lack of understanding significantly hampers efforts to optimize the effectiveness of behavioral interventions and limits their dissemination and implementation into widespread practice to curtail the adverse consequences of obesity and depression and promote population health.
Rapid advances in human neuroscience and behavioral science and integration of the two could provide unique opportunity to fill this gap. Objective: Leveraging a recently funded 2-year randomized controlled trial (RAINBOW, target n=404; PI Dr. Jun Ma) of a first-ever integrated treatment for comorbid obesity and depression in primary care that uniquely combines 2 nationally recognized behavioral interventions, we propose a 2-phased project to identify, validate, and refine a set of assays to measure self-regulation targets; and to engage these targets to optimize behavioral treatment of obesity and depression.
Specific Aims: In the UH2 phase, we will:
(1) Conduct secondary data analysis and hold workshops and a symposium to finalize selection of self-regulation targets and assays for testing
(2) Leverage the RAINBOW intervention to engage identified targets
(3) Verify target engagement across multiple domains (neural, physiological, behavioral, psychological), settings (laboratory, virtual, and naturalistic), and time points (0, 4 weeks, 6, 12 and 24 months).
Transitional milestones are to:
(1) Establish assay(s) that reliably and accurately measure the identified targets;
(2) Demonstrate malleability of the self-regulation target(s) in response to the RAINBOW integrated treatment
(3) Identify self-regulation profile(s) that predict treatment response in health behaviors (medical regimen adherence, physical activity, diet) and outcomes (weight, depression).
In the UH3 phase, we will conduct a pilot randomized controlled trial in which an additional 100 obese and depressed adults will be randomized to intervention or wait-list control and assessed at baseline, 4 weeks and 6 months.
Intervention subjects will receive the first 4 weeks of the RAINBOW intervention, followed by target-guided tailoring of the intervention components in order to optimize target engagement and enhance behavioral change based on their individual self-regulation profile during the first 4 weeks. We will use the insights from intervention subjects to then further refine the tailoring strategies for the waitlist subjects.
Implications: This research will provide a toolkit of well-validated assays of self-regulation targets important for health behavior change, as well as target-guided personalization of intervention strategies, in the treatment of comorbid obesity and depression.
Impact: Given the widespread relevance of these disorders and the targeted health behaviors, this research will be a prototype for treating multiple chronic conditions with profound potential impacts on population health.
PIs are Jun Ma, MD, PhD, University of Illinois at Chicago, and Leanne Williams, PhD, Stanford University.
Additional Co-Investigators are Jeremy Bailenson, PhD, Olivier Gevaert, PhD, Philip W. Lavori, PhD, all with Stanford University, and Mark B. Snowden, PhD, University of Washington.
Principal Investigator
External PI, Principal Investigator
Funder
National Heart, Lung, and Blood Institute
Start Date
September 15, 2015
End Date
June 30, 2018
Research Topics
Related Studies
A Study of Trends in Obesity Progression Among Complex Patients
We propose an innovative exploratory research project focusing on patients with a
constellation of three chronic conditions: (1) obesity, (2) hypertension, and (3)
depression.
Investigator(s): Harold (Hal) Luft, Ph.D.
Cardiovascular Disease Among Asians and Pacific Islanders (CASPER)
Examine: CVD prevalence & outcomes among Asians and Pacific Islanders; demographic,
clinical, psychosocial factors to explain prevalence & outcomes differences.
Investigators: Jiang Li, Ph.D., MPH, External PI, Principal Investigator
HCSRN Mental Health Research Network
Consortium focuses on improving individual and population mental health through research,
under auspices of Health Care Systems Research Network.
Investigator(s): Ellis C. Dillon, Ph.D.
HOMBRE (Hombres con Opciones para Mejorar el Bienestar y bajar el Riesgo de Enfermedades crónicas)
A pragmatic, comparative effectiveness trial: obese Latino men will receive, by random
assignment, the HOMBRE intervention or a minimal intensity intervention.
Investigator(s): Kristen M.J. Azar, R.N., BSN, MSN/MPH
Major Depressive Disorder
Purpose is to use EHR to understand the management of major depressive disorder in
a large healthcare system, to incorporate pt-reported data in care workflow.
Investigators: Kristen M.J. Azar, R.N., BSN, MSN/MPH, Alice R. Pressman, Ph.D., M.S.
Mental Health Communication in Elderly Primary Care Visits and Economic Outcomes
We specifically aim to examine the productivity of physician-patient communication
by linking elements of quality of communication on mental health in the context of
busy clinics and competing demands from co-morbidities.
Pilot Program to Expand Behavioral Health Care for Adolescents Within Palo Alto Medical Foundation and Mills-Peninsula Health Services
This is a 5-year program to implement and evaluate integration of behavioral health
into PAMF primary care settings, focusing on adolescents.
Investigators: External PI, Principal Investigator, Ellis C. Dillon, Ph.D.
Research Aimed at Improving Both Mood and Weight (RAINBOW)
Evaluate effectiveness of integrated behavioral weight loss program and stepped care
for depression in primary care setting.
Severe Mental Illness and Patterns of Emergency Department Utilization
Purpose is to provide descriptive info for improving health outcomes by identifying
a subgroup of high-frequency ER patients who may have severe mental illness.
Investigators: Kristen M.J. Azar, R.N., BSN, MSN/MPH, Alice R. Pressman, Ph.D., M.S.